Fear Of Physical Activity Research Articles

A Closer Look at Parental Anxiety in Asthma Outpacing Children's Concerns: Fear of Physical Activity over the Fear of Drug Side Effects.

The recognition of comorbidities is relevant for asthma management, especially if these conditions/diseases are treatable traits such as anxiety. This study aimed to explore the associations between asthma severity and child and parent asthma-related anxiety and to recognize the most common specific fears. This cross-sectional study consisted of 150 parents and their children diagnosed with asthma, and was conducted at the Pediatric Clinic of the University Hospital Center Split in Croatia. All children, from ages 3 to 17 years, underwent a thorough clinical examination. A total of 150 parents and 108 children filled out an asthma-related anxiety questionnaire in paper form. Parents of children with moderate and severe asthma had higher asthma-related anxiety due to restrictions related to asthma symptoms (p = 0.032), and children diagnosed with moderate and severe asthma had greater anxiety due to restrictions related to asthma symptoms than children diagnosed with mild asthma (p = 0.004). Children's anxiety was the highest when they experienced an asthmatic attack during physical activity (PA), and they fear that they will not be successful in sports or dancing due to asthma. Parents commonly reported the fear of an asthma attack without warning signs (p < 0.001), fear of drug side effects (p < 0.001), fear of absence from school (p = 0.006), and fear of an asthma attack during PA (p < 0.001). The current study reports findings of increased parental levels of anxiety when compared to their children, related to fear of an asthma attack occurring without warning signs, fear of side effects and fear of absence from school, as well as the fear of an asthma attack occurring during sports activities. When assessing individual items on anxiety associated with asthma, children most commonly reported concern related to physical activity.

Fear of physical activity relates to cardiac interoception and symptom distress in patients with chronic heart failure

BackgroundPatients with chronic heart failure often experience symptoms during physical activity, such as shortness of breath and tachycardia, which may result in fear of physical activity (FoPA). This study tested whether interoception (i.e., the perception of body sensations) and symptom distress (i.e., negative appraisal of symptoms) are associated with FoPA in outpatients with chronic heart failure. MethodFoPA was assessed with the Fear of Activities in Situations (FActS) in patients with diagnosed heart failure and healthy controls. A heartbeat tracking task and self-reports were used to assess interoceptive accuracy and interoceptive attention in patients and controls. Heart failure-related distress was assessed using ratings of symptom and treatment burden in patients. Multiple regression models were calculated to determine associations with continuous FoPA scores. ResultsPatients with low FoPA perceived their heartbeats more accurately than patients with high FoPA and healthy controls. Interoceptive accuracy and symptom distress explained almost half of the variance in FoPA, after adjustments for sex and disease severity, in patients with heart failure. ConclusionsIn patients inaccurate interoception and symptom distress were associated with high FoPA, independent of heart failure severity. The perception and appraisal of cardiac arousal and symptoms during physical activity deserve further attention to develop interventions to reduce FoPA in patients with heart failure. ClinicalTrials.gov IdentifierNCT03119298.

Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry.

This study attempted to explore the barriers to physical activity of older patients with Hypertension. It aimed to provide robust evidence produced through their eyes. First, through the data analysis of the accelerometer and the decision of the research team, 10 out of the 30 applicants were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Photovoice participants can communicate their unique experiences through photographs, providing a highly realistic and authentic perspective that is not possible to be understood with traditional qualitative research. This study inductively identified four main themes; health illiteracy, distortion of health information, fear of physical activity, and rejection of any life changes. Based on a specific understanding of the population's perception of physical activity, this study attempted to provide evidence of why many elderly Korean patients with Hypertension stay inactive.

Gluteal Central Activation in Females With Patellofemoral Pain: A Preliminary Study

Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observed weakness. The central activation ratio (CAR) is a common metric used to quantify muscle inhibition via burst superimposition. However, gluteal inhibition has yet to be evaluated using this approach in females with PFP. The study objectives are to (1)describe gluteal activation in the context of subjective function, hip strength, and squatting biomechanics and (2)examine the relationship of gluteal activation with subjective function and squatting biomechanics in females with PFP. Cross-sectional. Seven females with PFP (age = 22.8 [3.6]y; mass = 69.4 [18.0]kg; height = 1.67 [0.05]m, duration of pain = 6-96mo) completed this study. Subjective function was assessed with the Anterior Knee Pain Scale, while fear-avoidance beliefs were assessed with the Fear-Avoidance Belief Questionnaire physical activity and work subscales. Biomechanical function was assessed with peak hip and knee angles and moments in the sagittal and frontal planes during SLS. Gluteus medius (GMed) and gluteus maximus (GMax) activation were assessed with the CAR. Descriptive statistics were calculated, and relationships between variables were assessed with Spearman rho correlations. The CAR of GMed and GMax was 90.5% (8.1%) and 84.0% (6.3%), respectively. Lesser GMed CAR was strongly associated with greater hip adduction during SLS (ρ = -.775, P = .02) and greater fear-avoidance beliefs-physical activity subscale (ρ = -.764, P = .018). We found a wide range in GMed and GMax activation across females with PFP. Lesser GMed activation was associated with greater hip adduction during SLS and fear of physical activity, suggesting that gluteal inhibition should be assessed in patients with PFP.

The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis

BackgroundTo apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP).ObjectivesThis study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors.DesignThis study was a systematic review and meta-analysis of a randomised controlled trial. MethodLiterature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment.ResultsThree studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low.ConclusionsThree studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future.Trial registrationPROSPERO registration number CRD42020158182.

The relationship between psychosocial factors and reported disability: the role of pain self-efficacy

BackgroundChronic pain and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is now considered a world level crisis. Chronic non-specific low back pain (CNLBP) contributes a significant proportion to the chronic pain population. CNLBP occurs with overlapping psychosocial factors. This study was design to investigate specific psychosocial factors and their influence on reported disability in a population with CNLBP.MethodsThe specific psychosocial factors examined included fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study investigated the mediating role between pain self-efficacy, the specific psychosocial factors, and reported disability. The study recruited 61 female and 29 male participants from physical therapy clinics. The participants were between 20-to-60 years of age and diagnosed with CNLBP. All participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index. The battery of questionnaires measured fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability. Multivariate regression and mediation analyses was used to analyse the data.ResultsThe principal finding was a strong inverse relationship between pain self-efficacy and reported disability with a p-value < 0.001. Further, pain self-efficacy was considered a statistical mediator with consistent p-value < 0.001 for the specific psychosocial factors investigated within this data set. Pain self-efficacy was considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, age and reported pain levels proved to be statistically significant. Adjustments for age and pain level did not alter the role of pain self-efficacy.ConclusionThe results identified a mediating role for pain self-efficacy between the specific psychosocial factors (fear, catastrophizing, and depression) and reported disability. Pain self-efficacy plays a more significant role in the relationships between these specific psychosocial factors and reported disability with CNLBP than previously considered.

ISSLS PRIZE IN CLINICAL SCIENCE 2021: What are the risk factors for low back pain flares and does this depend on how flare is defined?

Although risk factors for new low back pain (LBP) episodes and acute-to-chronic transition have been identified, risk factors for flares of LBP remain largely unknown. This case-crossover study aimed to identify: (1) risk factors LBP flares and (2) whether risk factors differed when flare is defined by pain increase (pain-defined flare: PDF) or identified by participants according to a broader flare definition that considered emotions and coping (self-reported flare: SRF). One hundred and twenty-six participants with LBP for > 3months were included. Candidate risk factors and flares (PDF/SRF) were assessed daily using a smartphone application for 28days. Data on exposure to risk factors one, two and three days preceding PDF/SRF were compared to control periods. Conditional logistic regression estimated associations between risk factors and PDF/SRF. Odds of PDF and SRF were increased by poor sleep quality and morning pain. Good sleep quality reduced odds of flare. Odds for increased pain (PDF), but not SRF, were increased after days with higher afternoon and evening pain, fatigue, fear of physical activity and leisure physical activity. LBP flare has been largely ignored but is more reflective of the LBP experience than conventional definitions of acute, sub-acute and chronic LBP. This study highlights risk factors for flare and that these differ depending on whether flare is defined by pain alone (PDF) or a broad multidimensional definition (SRF). Potential targets to reduce the intensity/frequency of LBP flares are identified, with strong indication for the potential role of sleep intervention to mitigate LBP flare risk.

Examining what factors mediate treatment effect in chronic low back pain: A mediation analysis of a Cognitive Functional Therapy clinical trial.

Cognitive Functional Therapy (CFT) is a physiotherapist-led individualized intervention for people with people with non-specific chronic low back pain (CLBP), involving biopsychosocial pain education, graded movement exposure and lifestyle coaching. A multicentre randomized controlled trial (RCT), including 206 participants with CLBP in Ireland, supported CFT's effectiveness for reducing disability, but not pain, compared to a group exercise and education intervention. In this study, causal mediation analysis was used to determine whether the effect of CFT on disability and the lack of effect on pain (relative to a group exercise and education intervention) is mediated by certain psychological and lifestyle factors. Hypothesized mediators measured were pain self-efficacy, stress, fear of physical activity, coping, depression, anxiety and sleep, at 6months. The outcomes measured were functional disability and pain intensity at 12months. This causal mediation study shows that the majority of benefit of CFT (relative to a group exercise and education intervention) for disability is due to increasing pain self-efficacy. Conclusion: CFT did not improve the majority of the hypothesized mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these mediators were not associated with either disability or pain. Unfortunately, the proportion of missing data in this study is substantial and these findings can only be considered hypothesis-generating. Therefore, future research should examine replicating the results of this study to verify the role of self-efficacy and other proposed mediators (e.g. stress, coping, sleep, fear) on clinical outcomes. An exploration of seven potential mediators was undertaken to determine the effect of Cognitive Functional Therapy (CFT) on disability and pain intensity in individuals with chronic low back pain compared to a group exercise and education intervention. CFT improved pain self-efficacy, which was associated with disability and pain outcomes. CFT did not improve the other six potential mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these were not associated with disability or pain. The proportion of missing data in this study is substantial and these findings should be considered hypothesis-generating only.

Modulation of startle and heart rate responses by fear of physical activity in patients with heart failure and in healthy adults

Fear of physical activity (FoPA) has been suggested as a barrier to physical activity in patients with heart failure and might be associated with low adherence to exercise regimen despite medical guideline recommendations. The present study examined physiological indicators of FoPA by assessing startle modulation (via EMG at the orbicularis oculi muscle) and heart rate responses (derived from ECG) after affective priming with lexical stimuli of positive, neutral, and negative valence, as well as words related to physical activity as potentially phobic cues. After screening for FoPA in patients with heart failure and healthy adults, twenty participants each were assigned to one of three subsamples: a healthy control group and two cardiac patient groups scoring either low or high on FoPA. The high-FoPA group showed startle potentiation and more pronounced heart rate acceleration (than did controls) in the phobic prime condition, indicating defensive response mobilization. Among the patients, higher FoPA accounted for 30% of the startle potentiation by phobic priming, whereas general anxiety, depression, and disease severity were no significant predictors of startle modulation. These findings suggest that FoPA in patients with heart failure is associated with defensive responses on a physiological level that might be indicative of avoidance behavior, thereby contributing to low adherence to exercise regimen. Thus, FoPA presents a significant target for psychological interventions to foster physical activity in cardiac patients.

Behavior Change Following Pain Neuroscience Education in Middle Schools: A Public Health Trial.

Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school students either received a PNE lecture (n = 220); usual curriculum school pain education (UC) (n = 198) or PNE followed by two booster (PNEBoost) sessions (n = 250). Prior to, immediately after and at six-month follow-up, pain knowledge and fear of physical activity was measured. Six months after the initial intervention school, physical education, recess and sports attendance/participation as well as healthcare choices for pain (doctor visits, rehabilitation visits and pain medication use) were measured. Students receiving PNEBoost used 30.6% less pain medication in the last 6 months compared to UC (p = 0.024). PNEBoost was superior to PNE for rehabilitation visits in students experiencing pain (p = 0.01) and UC for attending school in students who have experienced pain > 3 months (p = 0.004). In conclusion, PNEBoost yielded more positive behavioral results in middle school children at six-month follow-up than PNE and UC, including significant reduction in pain medication use.

Fear of Physical Activity, Anxiety, and Depression

Abstract. Background: Physical activity (PA) is recommended by heart failure treatment guidelines. Adherence to exercise prescriptions is low and not much is known about everyday PA in this patient group. Aims: This study describes objectively assessed everyday PA/sedentary behavior in men and women with chronic heart failure and examines associations of potential barriers for engaging in PA, namely fear of physical activity (FoPA), general anxiety, and depression, with indicators of PA and sedentary behavior. Method: In 61 outpatients with heart failure (67.5 ± 10.7 years of age) the impact of FoPA, trait anxiety, and depression on 6-day accelerometer measures was evaluated using linear regression models. Results: Sedentary behavior was prevalent in men and women alike, with lying down and sitting/standing as predominant activity classes during daytime. Men had higher PA energy expenditure (726 vs. 585 kcal/d, Cohen’s effect size d = 0.74) and walked up/down more often (0.21% vs. 0.12% of total PA, d = 0.56) than women. FoPA did not differ between sexes. FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates (β-values between −0.26 and −0.44, p-values &lt; 0.024). Limitations: The self-selected sample included few women. Medical data were assessed via self-reports. Conclusion: FoPA, but not anxiety and depression, significantly and consistently predicted less walking up/down independent of covariates. These preliminary findings highlight FoPA as a barrier to everyday PA in patients with heart failure.

Study of Phobic Manifestations and Anxiety in Patients with Coronary Heart Disease after Myocardial Infarction in View of Tasks of Psychological Rehabilitation

The study of the psycho-emotional features of patients with coronary heart disease (CHD) is important for the development of psychological rehabilitation measures. In particular, it is necessary to take into account the specifics of the experienced fears and anxiety states which can be manifested in patients after myocardial infarction (MI). Negative psycho-emotional experiences are known to influence the course and prognosis of the disease. Identification of the structure of phobic manifestations, anxiety and personal characteristics of patients is appropriate for optimizing psychodiagnostics and psychocorrection. The present research is aimed at studying the characteristics of phobic manifestations and the structure of anxiety in patients with coronary heart disease (CHD) after myocardial infarction (MI), considering the dominant state, indicators of quality of life and personal characteristics. In the course of the present study 67 patients were surveyed with gender distribution of 12 women (18%) and 55 men (82%): patients of the Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation who had a history of myocardial infarction (up to 1 year) and had undergone myocardial revascularization. The average age of the patients was 58.95 years. Clinical interview and psychological testing (Dominant State Determining Method, Integrative Test of Anxiety, The 36-Item Short Form Health Survey (SF-36), The Big Five Personality Test) were used. In patients with CHD after MI with substantial fears the most frequently detected phobic manifestations are the fear of physical activity and the fears associated with the disease itself. In the group of patients with the presence of phobic manifestations more pronounced indicators of anxiety, lower indicators of quality of life (QoL) and emotional stability in the structure of personal characteristics were noted. When planning psychological rehabilitation for patients with CHD who have undergone MI, it is important to consider the likelihood of anxiety and phobic manifestations.

Living with Alpha-1 Antitrypsin Deficiency: Empowering Patients and Healthcare Professionals

Exacerbations in chronic obstructive pulmonary disease (COPD) impose a substantial healthcare burden and are key drivers of negative clinical outcomes and reduced patient quality of life. Prof Stockley highlighted the main differences in exacerbations between alpha-1 antitrypsin deficiency (AATD) and non-AATD-related COPD and considered potential implications for patient management. Early treatment of exacerbations with purulent sputum is known to be associated with improved patient outcomes. Emerging evidence from clinical studies also suggests that alpha-1 antitrypsin (AAT) therapy can have a positive impact on the nature and course of exacerbations in AATD. Dr Zanichelli outlined how self-administration of intravenous drugs, which is a routine procedure that patients safely implement in other indications, has the potential to be successfully used by carefully selected AATD patients. Reflecting the current trend towards a more personalised approach to AATD therapy, self-administration can empower patients to assume an increasingly active role in their own disease management, thereby bringing improvements in treatment satisfaction, disease control, clinical outcomes, and quality of life. A unique patient’s perspective on AAT self-administration was provided by Karen Skålvoll, who highlighted the key benefits offered by self-infusion, such as reduced localised trauma and increased freedom to travel and enjoy life. Photographs from Karen’s many global travels illustrate the unparalleled freedom that self-administration has afforded her as an AATD patient. From the physician’s standpoint, Prof Sandhaus summarised his experience of how patients can be empowered to self-administer AAT therapy independently with minimal training. Among motivated individuals, self-administration can provide a successful long-term treatment solution for their AATD. The drive towards self-treatment also delivers the dual benefits of reduced healthcare burden and enhanced convenience and flexibility for patients. Prof Koczulla reported that, overall, the available evidence indicates pulmonary rehabilitation as a successful strategy in AATD, which can significantly enhance a patients’ physical performance. Although the most effective training algorithm still needs to be prospectively validated, this approach may prove particularly advantageous in patients with anxiety, dyspnoea, and fear of physical activity. In order to achieve maximum benefit, therapy and goals of pulmonary rehabilitation must always be tailored to the individual patient in a personalised approach to care. The meeting concluded with the compelling ‘AATD Strongman Contest,’ which pitted Prof Koczulla against AATD patient Karen Skålvoll in a physical test of endurance (the so called ‘farmer’s walk’ involving carrying a heavy obstacle) and strength (dumbbell raises). Notwithstanding the expected impairment in aerobic ability, the domination of Karen in the strength test clearly demonstrates the physical gains that patients with AATD can achieve with physical training.

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD.

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.

The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD.

Anxiety is a highly prevalent psychological comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has detrimental effects on pulmonary rehabilitation (PR) outcomes. It has been suggested that disease-specific fears could play an even more important role in COPD patients' disease progression. However, little is known about how different disease-specific fears impact COPD. This study examined how different disease-specific fears relate to different PR outcome measures in COPD patients and how these relationships evolve over the course of PR. Before and after a 3-week inpatient PR program, COPD patients (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears (fear of physical activity, fear of dyspnea, fear of disease progression, fear of social exclusion) were assessed with the COPD-Anxiety-Questionnaire-Revised. Health-related quality of life (HQoL), COPD health status, dyspnea in daily life, depression, and anxiety were measured using validated questionnaires. Multiple regression showed that greater disease-specific fears at the start of PR were associated with worse functional exercise capacity, HQoL, health status, and depression at the start and end of PR (controlling for age, sex, lung function, smoking status, and general anxiety). Patients who showed a stronger decrease in disease-specific fears improved more in PR outcome measures over the course of PR. Furthermore, different disease-specific fears were related to different PR outcome measures. The results show that disease-specific fears are associated with treatment outcome measures, both cross-sectionally and prospectively. Therefore, disease-specific fears should be addressed in COPD patients as they might play a significant role in disease progression.

Perceived Stress Levels May Impact Upper Extremity Function Among Women Treated for Breast Cancer

Abstract Date Presented 4/20/2018 Positive relationships between lower perceived arm function and higher perceived stress and fear of physical activity were demonstrated among breast cancer survivors with functional shoulder range of motion. Stress-reducing techniques when engaging in occupations to restore function may be beneficial. Primary Author and Speaker: Anne Fleischer Contributing Authors: Mary Fisher

Wpływ rehabilitacji na poprawę wydolności fizycznej ocenianej za pomocą sześciominutowego wysiłkowego testu marszowego

Introduction. Chronic obstructive pulmonary disease – COPD (bronchitis and emphysema) is the most common chronic respiratory disease. It is the fourth leading cause of death, and its mortality rate has a rising tendency. Substances contained in tobacco smoke are the main cause of COPD. Reported symptoms include cough, increased sputum cough-up, dyspnea, and subsequent fear of physical activity. Even though it cannot be cured, physical exercise can increase the patient’s physical capacity; it delays the onset of disability, helping the patient to stay fit. Aim. The purpose of the essay was to find out what impact has rehabilitation on patients carrying COPD. Material and methods. The 6-minute walk test was used on the patients carrying COPD at the beginning and at the end of the rehabilitation. The results were identified by using statistical analysis. Results. Obtained results proved that the patients participated the rehabilitation improved their physical exercise capacity. Slightly better results were noticed in male patients. Discussion. COPD is an incurable disease, physical exercise can increase the patient's physical capacity; it delays the onset of disability, helping the patient to stay fit. Patients often avoid physical exercise due to "shortness of breath", but it is exercising that facilitates their proper functioning. The most effective diagnostic test is spirometry which measures lung function, specifically volume and flow of air that can be inhaled and exhaled. COPD is a multi-organ disease, apart from lungs it also attacks muscles, bones or heart. Therefore the treatment and rehabilitation should involve the whole body rather than focus on the respiratory muscles only. Conclusions. Pulmonology rehabilitation has significant influence on patients carrying COPD; improves efficiency and life quality.

Measuring Fear of Physical Activity in Patients with Heart Failure.

Fear of physical activity (FoPA) has been suggested as a psychological barrier to exercise-based cardiac rehabilitation and everyday physical activity (PA) in patients with heart failure (HF). We evaluated the recently developed Fear of Activity in Situations-Heart Failure (FActS-HF) questionnaire that assesses affective/cognitive fear reactions to situations of varying PA intensities. The FActS-HF was given to 132 ambulatory patients with stable HF (67 ± 12years, 80% men). In 121 participants with valid FActS-HF data, the questionnaire's dimensionality was investigated. Psychometric properties were determined in terms of reliability and validity. We assessed convergent and discriminantcorrelations of FoPAwith anxiety, kinesiophobia, and depression. External validation criteria encompassed clinical variables and objectively assessed accelerometer measures of everyday PA in a subsample of 61 participants. The FActS-HF measures a unidimensional construct (i.e., FoPA) based on items presenting varying PA intensities (i.e., the more intense the PA, the stronger the fear response). The scale demonstrated good 2-week stability (r tt = 0.82) and excellent internal consistency reliability (α = 0.97). FoPA was moderately to strongly associated with anxiety and kinesiophobia, and weakly to moderately associated with state/trait depression, supporting convergent and discriminant validity, respectively. High FoPA was associated with feeling uninformed about HF, comorbidities, non participitation to cardio fitness groups, and less stair climbing, as measured by accelerometry. The FActS-HF is a reliable and valid instrument to measure FoPA in patients with HF and provides a promising tool for further research and practice.

Perceived Stress Levels May Impact Upper Extremity Function Among Women Treated for Breast Cancer

Women treated for breast cancer report ongoing disability in their involved upper extremity, however, often objective measures do not appear to explain the level of perceived dysfunction. The purpose of this study was to investigate the relationship between perceived stress level, fear of physical activity and self-reported upper extremity function among women treated for breast cancer.

Osteoarthritis and fear of physical activity—The effect of patient education

Purpose: The aim of the current study was twofold. The first aim was to investigate, from the aspects of gender, age and Body Mass Index, the prevalence of fear among individuals with osteoarthriti ...